Tobacco use among the nation鈥檚 secondary school students is down, a new federal survey finds.
But the drop comes mostly among high school students, whose tobacco use has been declining since the pandemic. Younger students have begun to take up the drug again.
Some 2.8 million secondary students reported currently using tobacco in 2023, according to the . That鈥檚 1 in 10 middle and high school students, but it represents a significant drop from 3.08 million young tobacco users in 2022.
The nationally representative survey, conducted by the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention, finds that in 2023, 12.6 percent of students in grades 9-12 reported using tobacco in the last 30 days, down from 16.5 percent of high schoolers in 2022.
Tobacco habits among older and younger students have diverged since 2019. While initially plummeting for all secondary students during widescale pandemic lockdowns, younger students have begun returning to tobacco use, vaping in particular.
Linda Richter, the senior vice president for prevention research and analysis at the nonprofit Partnership to End Addiction, said she wasn鈥檛 surprised by the decline in tobacco use among older students.
Older teens today entered adolescence during a wave of anti-vaping legislation and research sparked in part by a 2019 鈥攊ncluding hospitalizations and deaths鈥攁mong middle and high school students exposed to e-cigarettes.
Then, during the pandemic, 鈥渢he closing of schools and stay-at-home orders that followed reduced kids鈥� vaping, as they were now away from their friends and under the watchful eyes of their parents,鈥� Richter said, noting that research early in the pandemic suggested vaping could increase the risk of contracting COVID and having more severe respiratory problems for the infected.
But younger students may not have received as much exposure to anti-vaping messages, finds Bebi Davis, the vice principal of Kaw膩nanakoa Middle School in Hawaii. 鈥淚t鈥檚 become a middle school trend,鈥� Davis said.
Davis has seen a rise in vaping, particularly among younger girls. 鈥淚 feel like everything happens at the middle school, because the kids鈥� bodies are still developing, their brains are still developing, but they鈥檙e not making the best judgment calls yet,鈥� she said. 鈥淭hey want to try everything in the world and they don鈥檛 understand what everything in the world does to them.鈥�
It can be difficult for teachers and administrators to keep on top of changing tobacco technologies, too. When students first started using vape sticks, teachers mistook them for pens, Davis said. Now, they can spot e-cigarette devices, but last week, staff at Kaw膩nanakoa found what looked at first like candy but turned out to be oral tobacco pouches.
鈥淭he kids are sometimes two steps ahead of where we are in terms of what鈥檚 available [for tobacco] in the stores,鈥� she said.
Rising use among girls
In both middle and high school, 鈥攑articularly electronic and traditional cigarettes鈥攁 trend that continues from 2022.
Richter said rates of drug use across a variety of substances are rising for girls while those among boys are steady or declining. But, 鈥渢here are unique factors related to vaping that might explain its higher prevalence among girls,鈥� she said. 鈥淭he marketing of vaping, like cigarette marketing in years past, heavily targets females through its ads and messages that associate nicotine use with glamour, fashion, sophistication, and being thin or controlling one鈥檚 appetite.鈥�
The annual federal, in-school surveys asked more than 22,000 students in grades 6鈥�8 (for middle school results) and 9鈥�12 (for high school results )about their use of several different kinds of tobacco products. The data show most students who use any tobacco use more than one kind, including cigarettes, chewing tobacco, hookah pipes, and cigars.
For the last decade, electronic cigarettes have been the most common form of tobacco for both older and younger students. In 2023, 2.13 million, or nearly 8 percent of secondary students, said they had vaped in the last 30 days.
Public-health experts have warned the fruity and candy flavors that are common among e-cigarettes may draw more younger students. The survey finds nearly 9 in 10 students who actively vape use flavored e-cigarettes, and nearly 6 in 10 students use 鈥渋ce鈥� or 鈥渋ced鈥� flavors.
Studies find e-cigarettes just as harmful and addictive as other forms of tobacco, and the federal data show nearly 1 in 3 students who actively vape do so daily or nearly every day.
A majority of states have sued e-cigarette manufacturers for illegally marketing their products and selling to minors. While , the Juul e-cigarette company paid $480 million to settle 34 state lawsuits in 2021 and 2022, and a California judge approved a $255 million class action settlement in January.
鈥淭he decline in e-cigarette use among high school students shows great progress, but our work is far from over,鈥� says Deirdre Lawrence Kittner, the director of the CDC鈥檚 Office on Smoking and Health, in a statement on the data. 鈥淔indings from this report underscore the threat that commercial tobacco product use poses to the health of our nation鈥檚 youth. It is imperative that we prevent youth from starting to use tobacco and help those who use tobacco to quit.鈥�
That means doing more than just confiscating tobacco products and disciplining students caught using them, the CDC recommends.
Schools should move away from 鈥渟care tactics, threats, and simplistic 鈥榡ust say no鈥� messages鈥� to combat tobacco use, Richter said. More effective strategies, she said, are to:
- Teach students research-based information on the physiological effects of nicotine products;
- Acknowledge and affirm why these products might be appealing to young people;
- Offer healthier alternatives to address stress or anxiety;
- Help students become media-savvy about the way tobacco companies try to influence them; and
- Include parents in the conversation so that they can support the messages students receive at school.
In Hawaii, Kaw膩nanakoa Middle School overhauled its approach to tobacco prevention after realizing 鈥渢he punitive approach, the consequence approach hasn鈥檛 really been working,鈥� Davis, the vice principal, said. 鈥淚f you suspend them and send them home, they just have more time to vape at home.鈥�
Instead, this year, the school partnered with nurses to increase vaping education. Instead of suspension, when a student is caught with a vaping device or other tobacco product, the student and a parent or guardian must attend three, 50-minute sessions with a nurse to discuss medical problems and other tobacco hazards. The student then makes a plan with family and school officials to stop tobacco use and develop healthy habits.
This week, for example, Davis met with an 8th grader and his grandfather after the boy had been caught with an e-cigarette several times. The boy鈥檚 grandfather shared his own challenges with trying to quit tobacco.
鈥淎 lot of times kids are in denial,鈥� Davis said. 鈥淭hey鈥檙e like, 鈥榃e鈥檙e not hooked. We just do it for fun.鈥� They don鈥檛 realize they鈥檙e already addicted to these things and hiding it from their parents. And most times, parents don鈥檛 know these things are happening.鈥�
So far, Davis said, the conversation approach has been 鈥渨orking wonders; 90 percent of the time, if a student has that [anti-vaping] conversation, I don鈥檛 see them back in here again.鈥�
